Reductions In Anxiety Severity Research Articles

P-500 Digital support tools for fertility patients – a systematic review and meta-analysis of the effect of these tools on psychological outcomes and pregnancy rates

Abstract Study question Do digital support tools for fertility patients improve psychological outcomes and pregnancy rates? Summary answer Overall, digital support tools for fertility patients do not improve depression, anxiety or Fertility Problem Index scores but have a beneficial effect on pregnancy rates. What is known already There are numerous mobile and web-based digital health tools in reproductive medicine, but the research evidence supporting the effect on clinical outcomes and to mitigate the psychological effects of infertility is sparse. If existing digital tools have demonstrated effectiveness in their stated aims of providing psychological support to patients during the arduous process of fertility treatment, it is vital to identify this so they can be implemented and further developed to tackle this important problem. In addition, if any digital tools have shown a positive impact on pregnancy rates, this would be of great interest to patients and clinicians alike. Study design, size, duration The study was prospectively registered (PROSPERO-CRD42020156441). An initial systematic review identified digital support tools and their salient features. This study presents meta-analysis of the data from RCT studies of digital support tools identified. Meta-analysis was performed of pregnancy rates, FPI (Fertility Problem Index), Depression and Anxiety scores between the digital support tool user and waiting list control groups. Studies were assessed for risk of bias (Cochrane risk of bias, robvis tool) and graded for quality. Participants/materials, setting, methods All studies were published after 2006. The RCT studies were conducted in the USA, Switzerland, Germany, UK, and The Netherlands. The total number of patients involved was 1268 (1059 women and 209 men). The average age of participants was 34.3 years. All studies reported psychological outcome scores. In 5 of the 10 studies identified pregnancy rates were reported. Meta-analysis was performed using the ‘meta’ package in R using random effects model to generate forest plots. Main results and the role of chance Overall, digital tools have a small positive impact on pregnancy rates, suggesting a beneficial effect for users of digital tools compared to non-user controls. Comparing digital support tools users with non-users, the clinical pregnancy rate (CPR) odds ratio (OR, with confidence interval) was 1.715 (1.042:2.82). The meta-analysis of the effect sizes of digital interventions on psychological outcomes, measured using validated measures of anxiety, depression, or the fertility specific FPI, identified no significant effects of digital interventions on patients’ psychological wellbeing. There was no significant standardized mean difference seen with the FPI analysis, SMD -0.10 (95% CI -0.26:0.05). As a variety of depression and anxiety outcome scales were used, there was insufficient comparable data to perform a quantitative meta-analysis for these outcomes and so this data is presented narratively. No convincing benefit of the digital tools to reduce symptoms of depression during fertility treatment is demonstrated in these studies. The impact of digital support tools on anxiety scores is somewhat mixed, with most studies demonstrating no significant difference in the anxiety scores between intervention and control group and a small number of statistically and clinically significant reductions in anxiety severity. Limitations, reasons for caution Meta-analysis was limited by the range of psychological outcome scales used. There were issues with deviation from intended interventions and missing outcome data. There is a risk the results of this meta-analysis were affected by publication bias, particularly the reporting of pregnancy rate, which was not included in all studies. Wider implications of the findings Establishing an agreed framework or core outcome set for evaluation of tools aiming to ameliorate the psychological distress associated with fertility treatments would be useful. Further research to explore the potential of digital support tools to impact pregnancy rates, particularly within fixed time frames/ treatment cycles, is warranted. Trial registration number N/A

The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression

ABSTRACT Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Anxiety severity and prescription medication utilization in first-time medical marijuana users

BackgroundAnxiety and post-traumatic stress disorder (PTSD) are qualifying psychiatric conditions for medical marijuana (MM) treatment in Pennsylvania. This study examined baseline prevalence and changes in prescription anxiety medication use three months following MM treatment initiation among individuals with these qualifying conditions. MethodsThe study sample was comprised of 108 adults with anxiety or PTSD as a referring condition; they were enrolled in a longitudinal study evaluating biopsychosocial outcomes in new MM patients. Consenting participants completed an assessment battery at baseline and Month 3 (n = 94, 87 % follow-up rate) that included a measure of anxiety severity and questions about current anxiety medication prescription and desired (baseline) and actual (Month 3) reductions in medication use. ResultsFindings indicated that 59 % of participants reported prescription medications for anxiety, with 70 % reporting at least a moderate desire to reduce medication use. Overall and within the medication sub-sample, participants displayed significant reductions in anxiety severity from baseline to Month 3 (p’s <0.0001). Furthermore, 32 % reported actual reductions in medication use at Month 3, and reductions were more likely among patients prescribed benzodiazepines than other drug classes. ConclusionsResults suggest that a significant number of MM patients with anxiety and/or PTSD diagnoses are currently being prescribed antianxiety medications and that MM may help to reduce their use of these medications. LimitationsLimitations include the observational study design and the lack of a PTSD-specific measure. More controlled longitudinal studies are necessary to better understand the role of MM in the treatment of anxiety and PTSD.

Mitigating Multiple Sources of Bias in a Quasi-Experimental Integrative Data Analysis: Does Treating Childhood Anxiety Prevent Substance Use Disorders in Late Adolescence/Young Adulthood?

Psychiatric epidemiologists, developmental psychopathologists, prevention scientists, and treatment researchers have long speculated that treating child anxiety disorders could prevent alcohol and other drug use disorders in young adulthood. A primary challenge in examining long-term effects of anxiety disorder treatment from randomized controlled trials is that all participants receive an immediate or delayed study-related treatment prior to long-term follow-up assessment. Thus, if a long-term follow-up is conducted, a comparison condition no longer exists within the trial. Quasi-experimental designs (QEDs) pairing such clinical samples with comparable untreated epidemiological samples offer a method of addressing this challenge. Selection bias, often a concern in QEDs, can be mitigated by propensity score weighting. A second challenge may arise because the clinical and epidemiological studies may not have used identical measures, necessitating Integrative Data Analysis (IDA) for measure harmonization and scale score estimation. The present study uses a combination of propensity score weighting, zero-inflated mixture moderated nonlinear factor analysis (ZIM-MNLFA), and potential outcomes mediation in a child anxiety treatment QED/IDA (n = 396). Under propensity score-weighted potential outcomes mediation, CBT led to reductions in substance use disorder severity, the effects of which were mediated by reductions in anxiety severity in young adulthood. Sensitivity analyses highlighted the importance of attending to multiple types of bias. This study illustrates how hybrid QED/IDAs can be used in secondary prevention contexts for improved measurement and causal inference, particularly when control participants in clinical trials receive study-related treatment prior to long-term assessment.

Efficacy of a prevention program for eating disorders in schools: a cluster-randomized controlled trial

BackgroundPrevious prevention programs in the school context have not addressed both genders, have been time-consuming, or have had deficits in the evaluation method. The aim of the present study was to evaluate the impact of a universal prevention program for female and male adolescents on eating disorder pathology and related risk factors.MethodsBetween February 2012 and July 2014, 2515 students in 23 schools from 8th or 11th grade were assessed for eligibility in this longitudinal cluster-randomized controlled trial with a six months follow-up. Of those students, 2342 were cluster-randomized to the intervention condition which received a six school hours universal prevention program or to the no treatment control condition.ResultsThe complete case population comprised 724 students in the intervention (54.3% female, M = 14.3 years, SD = 1.61) and 728 in the control condition (57.0% female, M = 14.7 years, SD = 1.63). Random-effects analysis of covariance on the primary outcome showed no significant differences between the intervention and control groups in their eating disorder pathology change scores six months after the intervention. Regarding secondary outcomes, participants in the intervention group showed a greater increase in knowledge about eating disorders both after the intervention (p < .001, ES = 1.06) and six months later (p = .01, ES = 0.40). Greater reductions in anxiety severity were observed in the intervention group post-intervention (p = .02, ES = 0.22) which was not maintained at the six months follow-up. Results differed between participants from grade 8 and 11.ConclusionThe present universal prevention program can be particularly recommended for adolescents from grade 11.Trial RegistrationISRCTN 97989348

A Preliminary Evaluation of a Home-based, Computer-delivered Attention Training Treatment for Anxious Children Living in Regional Communities

Many children with anxiety disorders live in communities with limited access to treatment. Attention bias modification training, a promising computer-based treatment for anxiety disorders, may provide a readily accessible treatment. Recent evidence suggests that a form of ABMT combining visual-search for positive stimuli with features to enhance learning, memory and treatment engagement reduces anxiety in children. The present study builds upon this research by comparing parent-implemented, visual-search attention training to positive stimuli (ATP) (N = 22) with a waitlist control group (WLC) (N = 19) in children living in regional communities. Diagnostic, parent- and child-reports of anxiety and depressive symptoms and broad internalizing and externalizing behaviour problems were assessed pre- and post-condition. Children in the WLC completed visual-search ATP after the wait period and all participants completed a follow-up assessment six-months after treatment. At post-treatment/wait period, children in the ATP condition showed greater improvements on clinician- and parent-report measures compared to children in the WLC. Similar post-treatment outcomes as those found for the ATP condition were observed at the six-month follow-up after all children had received ATP. Moreover, children who showed greater verbalization of explicit attention strategies related to positive search (assessed during treatment) achieved greater reductions in anxiety severity at post-treatment and six-month follow-up. Attention training towards positive stimuli using enhanced visual-search procedures appears to be a promising treatment for reaching anxious children living in regional communities.

Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale.

The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Participants were 73 children 7-13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status. Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings. With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice.

An Open Trial of Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents With Autism Spectrum Disorders

The frequent co-occurrence of anxiety disorders and autism spectrum disorders (ASD) in youth has spurred study of intervention practices for this population. As anxiety disorders in the absence of ASD are effectively treated using cognitive-behavioral therapy (CBT) protocols, an initial step in evaluating treatments for comorbid youth has necessarily centered on adaptation of CBT. One primary limitation of this research, to date, is that interventions for adolescents with anxiety disorders and ASD have not been systematically tested. In this study, 20 adolescents (90% male) with ASD and a comorbid anxiety disorder, between ages 11 and 14 years ( M = 12.2 years, SD = 1.11 years), participated in an open trial of modified CBT targeting anxiety with ASD. Findings demonstrated significant reductions in anxiety severity, as assessed by clinician and parent ratings, from baseline to post-treatment. In addition, reductions in parent-rated externalizing symptoms were observed. Gains were maintained at a 1-month follow-up.

A Pilot Study of Computer-Assisted Cognitive Behavioral Therapy for Childhood Anxiety in Community Mental Health Centers.

Anxiety disorders among children are common, disabling, and run a chronic course without treatment. Cognitive behavioral therapy (CBT) has shown robust efficacy for childhood anxiety. However, dissemination of CBT into community mental health centers (CMHCs) is limited. Computer-assisted CBT (CCBT) programs have been developed to improve dissemination by providing a structured treatment format that allows therapists to reliably deliver evidence-based treatments with fidelity. In this pilot study involving therapists with limited CBT experience, the effectiveness, feasibility, and acceptability of a CCBT program, Camp Cope-A-Lot (Khanna & Kendall, 2008b), were examined in three CMHCs. Seventeen youth ages 7-13 years and diagnosed with a primary anxiety disorder were enrolled. Assessments were conducted by a rater not involved in treatment at baseline and posttreatment. Significant reductions in anxiety severity and impairment were demonstrated at the posttreatment assessment. High levels of family satisfaction were reported. These results provide preliminary support for the effectiveness of a computer-assisted treatment into CMHCs and warrant replication in a controlled setting.

Facing Your Fears in Adolescence: Cognitive-Behavioral Therapy for High-Functioning Autism Spectrum Disorders and Anxiety

Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13–18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed.